Tag: technology

Case Management with Email Messaging

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Many of our customers include Case Management as part of the mix of services provided to clients. Among the seriously mentally ill (SMI) population, Case Management has become an essential service helping individuals gain the most from the services they receive. Helping the client take their medication as prescribed, assessing their current symptom status, intervening to alter treatment rapidly if a crisis is looming are all functions that Case Managers provide. These services are provided both in-person and by telephone.

A new study published in The Journal of General Internal Medicine suggests that email contact with a trained psychiatric nurse can dramatically improve the outcome of medication treatment for depression by internal medicine practices. Reported in Healthcare IT News on March 17, the study was a follow-up to a similar study using telephone contact with patients who had newly been started on antidepressant medication. According to the report, the email messaging was even more effective than a telephone call in improving the benefit of the medication.

The study utilized 208 members of Group Health, a consumer-governed, nonprofit, integrated healthcare organization that coordinates care and coverage for 600,000 individuals in Washington state and Idaho. The Group Health Research Institute (GHRI) was the responsible research organization. GHRI  is a non-proprietary, public-domain research institution within Group Health.

The Group Health plan includes a patient portal that has access into the organization’s electronic health record. According to the abstract of the article, the Intervention consisted of:

 Three online care management contacts with a trained psychiatric nurse. Each contact included a structured assessment (severity of depression, medication adherence, side effects), algorithm-based feedback to the patient and treating physician, and as-needed facilitation of follow-up care. All communication occurred through secure, asynchronous messages within an electronic medical record.

This study was motivated by poor improvement outcomes reported nationally for depressed individuals treated by their primary care providers with antidepressant medication. The goal of the entire research project is to determine if use of an organized plan of treatment including evidence-based follow-up services would result in greater effectiveness of medical therapy.

A significant movement is developing within the U.S. to improve outcomes of our healthcare system by providing services in non-traditional ways. The Connected Healthmovement seeks to improve healthcare services and outcomes by use of technology to remotely monitor and provide services. Partners Healthcare Center for Connected Health has been a pioneer in this effort. Their web site states the goal in this fashion:

Changing Healthcare Delivery

We are engaging patients, providers and the connected health community to deliver quality care outside of traditional medical settings. Telehealth, remote care and disease management initiatives reflect the opportunities for technology-enabled care programs.

What potentials do you see for the use of electronic methodologies like secure email communication with clients within your organization? Are you already engaged in such endeavors? What do you see as the obstacles to such care? What are the potential benefits to your clients? How do we get from here to there?

Please share your experiences, concerns and other comments below.

New Computer? Be prepared…

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I have spent much of the past week getting ready to use and then implementing a new computer. I have been reminded of a few things as I have gone through this process and thought I would share them with you just in case you are getting ready to go to a new machine any time soon.

This is not my first time changing machines. Over the past 30+ years, I have initiated the use of many new computers. As I have gotten older, I have become less good at making the changes and adaptations that must occur in this process. In fact, the last time I got a new desktop computer, I was so loathe to go through the time-consuming process of installing and setting up everything anew that I used a “suitcase” service to backup my old machine and setup the new computer from the image that had been created. As a result, certain registry entries were never properly initiated. I never had a working CD reader/writer in the last computer . . . even though three have been installed. I had mysterious failures and the blue screen of death way too often to make me happy. I won’t bore you with more details; just know that this shortcut method did not work to maximize my use of my new computer, but it did save me time initially.

Accordingly, here are my suggestions about going to a new computer.

  1. Don’t use the shortcut methods. They may save time at the front end but they will waste your time maddeningly over the years of your use of the new computer.
  2. Do make a complete list of all the programs you use on your current computer.
  3. Make sure you have installation CDs and license codes, or that you have downloaded the installer software for your programs to another computer on your network or with which you can share your new computer in order to get setup. Again, be sure you have the license codes somewhere other than on your current machine.
  4. Once you have made your list, check again. I was amazed at all the little programs I have downloaded over the years that are crucial to my day-to-day functioning. Do you use a zip program or a pdf creator/viewer or a screen clipping program? Do you have certain simple games that you enjoy for a quick break occasionally? Do you have gadgets or scratch pads or sticky notes or calendars that you rely on? Make a list and find the source of the programs before you make your switch.
  5. It is not usually necessary to have an expert set up your new computer for you, but it is very nice if you have the option of their assistance with installing the operating system and the larger/more complicated of your programs. If you are getting a Windows-based computer and buying Microsoft Office, having someone else install those programs for you can be a big time saver.
  6. Even if someone else installs these for you, you will still need to set up all your personalizations and special configurations. Your Favorites will be missing, so, if they are important to you print out lists of these things while you are creating your master setup list.
  7. If it is possible to continue using your current computer while you are setting up the new one, do so. That way you will be able to continue your work and productivity while all those installation programs are running.

Remember, your new computer is likely to be faster and to have some wonderful innovations that you have been anticipating with excitement. Don’t let yourself get so bogged down in the setup that you forget to enjoy all the new features and power!

Do you have a new computer story that you would like to share? Have you come up with some additional tips for getting started with a new machine that might be a help to someone who reads this blog? Please share your comments below. Thanks for reading.

New Phone Systems: Frustrations of an impatient newbie

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The last two weeks have been extremely challenging for me. As many of you know, I am not a techie; I am an end user. Without excellent in-house and outside product and computer support, I would not be a happy computer user most of the time.

We have been using a hosted PBX-style telephone system (Onebox) for the last couple of years. This service gives us the general functionality of a PBX system without the cost. We have extension numbers for each phone. We have automated attendants with different messages at different times of the day and night, as well as for Technical Support vs. Sales and Customer Service. We have multiple voicemail boxes at which customers can leave messages. We told the company what we wanted. They set it up for us. We use it.

Our one frustration has been the length of time needed to transfer a call from one person to another within our organization. It takes so long customers sometimes hang up. And sometimes transferring just does not work at all.

In 2009 and 2010 we have been cost saving fanatics. Since long distance telephone calls and numerous telephone lines are among our biggest expenses, we began to research options other than land lines and long distance contracts. About a year ago, we started using Voice over Internet Protocol (VOIP) telephone service through T-Mobile for our outgoing technical support calls. It has mostly done the job at a fraction of the cost of long distance service, so this month Seth started to research moving our entire telephone system to a hosted VOIP solution. After a couple of days of intense research, he decided that we should try Vocalocity, a company that focuses on small businesses.

Then Manon, our lead technical support staff person, left for vacation and my headache began. You see, Seth assists with doing tech support when one of our primary staffers is out. That meant the VOIP project was handed over to me…and oh what a mistake that was….because, remember, I am technologically impaired. Much of my other work has been on hold while I tried to make this work.

Seth had begun to set up our Auto Attendants, but they were not working properly. He emailed our phone system flow chart to a support representative at Vocalocity so they would know what we wanted to accomplish. Then, I needed to work with the support representative to make it happen. Over the course of three days, an excellent representative named Nathaniel worked with me to make changes in the setup of our account. It was much more complicated than either Seth or I realized. There were some things that had to be initiated on their end to accomplish our goals; they were not end user configurable. Finally, on Monday we tested all the work Nathaniel had done and the system appears to do what we want it to in the way we want. It even lets us transfer calls from one extension to another without a long wait time.

Today I called our telephone service provider and had our main line forwarded to the number assigned to us by Vocalocity. Tomorrow I expect to start receiving calls on the new system. We will let you know the outcome.

The moral of this story is this: using new technology may be just the way to save your organization lots of money; however, have your most tech-savvy person work to accomplish the goal. Giving the task to a less-than-patient person who just wants the darned thing to work is not the most effective way to adopt the new technology….no matter how cool the technology is.

What technology implementation stories do you have to share? Has your experience taught you some things about how to most effectively adopt new technology in your organization?

Just enter your comment in the box at the bottom of the page. If you don’t see a box, double click on the title of the article then scroll back down to the box to enter your comment. Please share your experience. I must get better at this!

Has the U.S. Become an Anti-Scientific Nation?

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On Sunday night our book club met to discuss Richard Dawkins’ Greatest Show on Earth. While I had a bit of difficulty with his style of writing, the data Dawkins presents in explication and support of evolution is exhaustive. Even with such overwhelming evidence, he reports that a full 44% of Americans surveyed in 2008 do not believe that evolution occurred. They deny the fact that all life forms on earth, including humans, descended from some common ancestor; Dawkins calls them 44% ‘history-deniers.’

On Saturday night, we finally saw Avatar. Among the themes explored in this movie was the strong prejudice that exists today against science and scientists. Technology…the practical outcome of scientific endeavor… is valued. Everyone on that space settlement was a technician of some sort. But the science that got them there and the science allowing the use of real avatars was denigrated by the majority.

A few weeks ago, I wrote about behavioral health professionals use of evidence based treatments. Behavioral health professionals and psychologists in particular are generally well-trained scientists, having a good understanding of the scientific method plus training in critical judgement of research. One goal of this education is to choose the soundest methods of providing care. And yet, large numbers of psychologists indicate that they do what they “believe” is best for their clients rather than what scientific research indicates is likely to provide the most effective course of treatment.

Numerous writers and commentators have bemoaned the state of science education in this country. At one time the U.S. was generally regarded to be the place to get the best education in science. Students from across the world came to the U.S. to study. Some stayed, some returned to their home lands to teach others. A 2007 article in the Christian Science Monitor ranked U.S. high school students 29th in the world in science literacy. While others would argue this figure, the common perception is that we have slipped as a nation in our interest in, and understanding of, science.

Simultaneously, we have become technology addicts. I would venture to say that many young people who are technology drones have never really thought about the science that went into creating the devices they cannot live without. Nor do they care that they do not know about the science. Just make sure that they continue to have access to their toys and to the technological infrastructure that supports them.

I believe this trajectory puts us as a nation in a very vulnerable position. Technological innovations are only one aspect of scientific endeavors. The knowledge gained from pure science is one of the things that keeps me most in touch with my creativity and my humanity. Take a listen sometime to Science Friday, an NPR program and podcast that weekly explores a whole variety of science topics and themes. It is impossible for me to listen to more than two or three of these shows without coming away with a book I want to read. I referenced one of these shows in my article on Evidence Based Treatment.

Those who provide behavioral health care services are unlikely to find the bulk of their work taken over by technology. There will be technologies that facilitate treatment and technologies that become treatments, but the bulk of human services will still be provided by humans. Assuring that we are good scientists, or at least can judge when a study is good science, is a worthwhile goal for behavioral health providers of every stripe.

How do you rate our science literacy? Are you interested in or bored to tears by science? Do you see science as relevant to your life…as a human being or as a provider of services?

Please enter your comments by clicking on the title of this article and typing in the box at the bottom of the page.

Remote Conversations: How do you do it?

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I’ve mentioned here pretty often than I am not a technology sophisticate. I use technology every day in my work life, but I am a slow-adopter. For some of you, this article may be so old-hat that you will ask “Kathy, where have you been?” But I know there are others out there like me, so here goes anyway.

My mother-in-law had back surgery in Miami early this month. Since my 89-year-old mother lives with us, it has been impossible for me to go down to see her since the surgery. This past weekend, we arranged to skype a conversation so she could talk to me and my mom and we could “see” how she is doing. That word I just used…”skype” did not exist as a verb until August 2003 when a group of Estonia-based developers released the first version of what became Skype.

So what in the world is a skype? It is a company that created a technology that allows one computer to make voice and video calls to another computer free of charge. It also allows one to make phone calls from your computer to land lines and cell phones for a very low charge. Of course, it is the free-of-charge calls to other computers, especially video calls, that makes it so exciting. The process of doing this has become “to skype” or “we skyped.”

The technology allows high quality computer connections without going through a telephone service. As long as you have a high-speed internet connection, there are no voice/video delays. As long as your web cams are decent quality, picture and voice quality are excellent…and Skype has built-in tools to help you improve quality if you are having any difficulty.

But here’s the rub…Skype has become so popular that our Sunday morning attempt to connect was unsuccessful. The servers were all busy! So what’s a computer video newbie to do? Well, use Google Chat instead, of course.

SOS has recently switched all of our email to a Google corporate account. This gives us access to a number of other tools…Google Chat is one that we have used in-house for instant messaging. While I only learned about this through our Google account (I told you I am technology-impaired), this tool is also available to anyone who wants to use it…just check out the link above. I had not input the settings correctly before this weekend, so we combined old-fashioned cell phone technology with Google Chat computer video. There was a lack of synchronization between our cell phone service and the video, but now that I have my webcam microphone set up as the sound source it will be synced on future calls.

Yahoo! Messenger has provided similar service and functionality for years, and for Microsoft fans, Windows Live Messenger also allows these same capabilities. Ichat is a similar service used by Apple aficionados.

I must tell you that I do not have much interest in using this technology for work, but for personal contacts with family members who live far away, these are wonderful tools. My assessment of this may change over time. For many of you, the time may be now. Video conferencing is a wonderful way for scholars and far-flung colleagues to work together. It is also a fantastic way to provide behavioral health services to remote and home bound clients.

Several months ago, a Florida psychology listserv to which I belong was the setting for considerable discussion about remote provision of services. While some of the practitioners were hesitant to consider providing psychotherapy via computer video, some have already begun doing so. Community behavioral health organizations are actively considering such services for rural clients and others who require case management but are not readily available for visits. Over time, providing low-income, seriously mentally ill individuals with an inexpensive computer, internet service and webcam could save thousands of dollars in case manager travel and time costs, not to speak of hospitalization costs when deterioration not noticed on a telephone call but readily apparent on a video conference, is beginning.

The biggest push for these services may come from Medicare, Medicaid and other payers. A December 2008 article from the American Telemedicine Association details Medicare’s authorization for payment for remote services. These are provider and location-of-recipient dependent, so check out the details before you decide to start billing Medicare for such services. Since psychotherapy is a covered service for the purposes of telehealth, I expect more practitioners will begin to provide these services. I hope more abundant research on comparative efficacy will follow.

Has your organization begun providing any services remotely using video conferencing? What methods do you use? What benefits and limitations do you experience? If you are not already providing services in this fashion, what might it take to move you to do so?

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